Brazilian Journal of Anesthesiology最新文献

{"title":"Impact of withholding early antibiotic therapy in nonseptic surgical patients with suspected nosocomial infection: a retrospective cohort analysis","authors":"Estevão Bassi ,&nbsp;Bruno Martins Tomazini ,&nbsp;Bárbara Vieira Carneiro ,&nbsp;Amanda Rodrigues de Oliveira Siqueira ,&nbsp;Sara Rodrigues de Oliveira Siqueira ,&nbsp;Thais Guimarães ,&nbsp;Fernando da Costa Ferreira Novo ,&nbsp;Edivaldo Massazo Utiyama ,&nbsp;Paolo Pelosi ,&nbsp;Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2023.03.003","DOIUrl":"10.1016/j.bjane.2023.03.003","url":null,"abstract":"<div><h3>Background</h3><p>Systemic inflammatory responses mimicking infectious complications are often present in surgical patients.</p></div><div><h3>Methods</h3><p>The objective was to assess the association between withholding early antimicrobial therapy while investigating alternative diagnoses and worse outcomes in nonseptic patients with suspected nosocomial infection in a retrospective cohort of critically ill surgical patients. The initiation of antibiotic therapy within 24 h of the suspicion of infection was defined as the Early Empirical Antibiotic strategy (EEA) group and the initiation after 24 h of suspicion or not prescribed was defined as the Conservative Antibiotic strategy (CA) group. Primary outcome was composite: death, sepsis, or septic shock within 14 days. Main exclusion criteria were sepsis or an evident source of infection at inclusion.</p></div><div><h3>Results</h3><p>Three hundred and forty patients were eligible for inclusion (74% trauma patients). Age, sex, reason for hospital admission, SAPS3 score, SOFA score, and use of vasopressors or mechanical ventilation were not different between the groups. Within 14 days of inclusion, 100% (130/130) of EEA patients received antibiotics compared to 57% (120/210) of CA patients. After adjusting for confounding variables, there was no association between primary outcome and the groups. In a post hoc subgroup analysis including only patients with <em>a posteriori</em> confirmed infection (by microbiological cultures), delay in initiation of adequate antimicrobial therapy was independently associated with the primary outcome (Odds Ratio = 1.19 per day of delay; 95% CI 1.05–1.37).</p></div><div><h3>Conclusions</h3><p>Withholding early empiric antibiotic therapy was not associated with progression of organ dysfunction within 14 days in nonseptic surgical patients with suspected nosocomial infection without an obvious source.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744431"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S010400142300026X/pdfft?md5=cdb57ceabf129b0aeca8c3491765c88c&pid=1-s2.0-S010400142300026X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and outcomes in cardiac surgery","authors":"Luiz Guilherme V. da Costa ,&nbsp;Fabio V. Papa ,&nbsp;Gregory M.T. Hare ,&nbsp;Marcello F. Salgado-Filho ,&nbsp;Eric B. Lineburger ,&nbsp;André P. Schmidt","doi":"10.1016/j.bjane.2024.844504","DOIUrl":"10.1016/j.bjane.2024.844504","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844504"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000265/pdfft?md5=ddde89cbe271425e7069c8bfd4eeab4e&pid=1-s2.0-S0104001424000265-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation and validation of the Iowa Satisfaction with Anesthesia Scale for use in Brazil: a cross-sectional study","authors":"Nicole Morem Pilau Moritz ,&nbsp;José Eduardo Moritz ,&nbsp;Gabriel Oscar Cremona Parma ,&nbsp;Franklin Dexter ,&nbsp;Jefferson Traebert","doi":"10.1016/j.bjane.2023.11.001","DOIUrl":"10.1016/j.bjane.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>The Iowa Satisfaction with Anesthesia Scale (ISAS) was developed to assess the satisfaction of patients undergoing sedation with monitored anesthesia care. This study aimed to cross-culturally adapt the ISAS instrument and evaluate the acceptability, validity, and reliability of the proposed Brazilian version (ISAS-Br).</p></div><div><h3>Methods</h3><p>The cross-cultural adaptation process involved translation, synthesis, back-translation, expert committee review, pre-testing, and final review of the ISAS-Br. A cross-sectional study was conducted, involving 127 adult individuals undergoing ambulatory surgeries with moderate/deep sedation. The acceptability, reliability, and construct validity of the scale were assessed.</p></div><div><h3>Results</h3><p>The cross-cultural adaptation process did not require significant changes to the final version of the scale. The ISAS-Br demonstrated excellent acceptability, with a completion rate of 99% and an average completion time of 4.6 minutes. Exploratory factor analysis revealed three factors: emotional well-being, physical comfort, and anxiety relief, with respective composite reliability coefficient values of 0.874, 0.580, and 0.428. The test-retest reliability of the ISAS-Br, measured by the intraclass correlation coefficient, was 0.67 (95% confidence interval [95% CI] 0.42 to 0.83), and the Bland-Altman plot showed satisfactory agreement between the measurements.</p></div><div><h3>Conclusion</h3><p>The proposed Brazilian version of the ISAS underwent successful cross-cultural adaptation according to international standards. It demonstrated good acceptability and reliability, regarding the assessment of temporal stability. However, the ISAS-Br exhibited low internal consistency for some factors, indicating that this instrument lacks sensitivity to assess the satisfaction of deeply sedated patients. Further studies are necessary to explore the hypotheses raised based on the knowledge of its psychometric properties.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744471"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423001161/pdfft?md5=71a197d31a430d2ba88a7897944960f1&pid=1-s2.0-S0104001423001161-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of hemoglobin with postoperative delirium and atrial fibrillation after cardiac surgery: a retrospective sub-study","authors":"Sinem Sari ,&nbsp;Jack Brooker ,&nbsp;Mateo Montalvo-Campana ,&nbsp;Peter Shehata ,&nbsp;Xuan Pu ,&nbsp;Steven Insler ,&nbsp;Kurt Ruetzler ,&nbsp;Christopher A. Troianos ,&nbsp;Alparslan Turan","doi":"10.1016/j.bjane.2023.02.003","DOIUrl":"10.1016/j.bjane.2023.02.003","url":null,"abstract":"<div><h3>Background</h3><p>Most cardiac surgery patients experience postoperative anemia. Delirium and Atrial Fibrillation (AF) are common and independent predictors of morbidity and mortality. Few reports examine their association with postoperative anemia. This study aims to quantify the association between anemia and these outcomes in patients undergoing cardiac surgery.</p></div><div><h3>Methods</h3><p>This post-hoc analysis of the DECADE randomized controlled trial ran at six academic US hospitals. Patients aged 18–85 years with heart rate &gt; 50 bpm undergoing cardiac surgery who had daily hemoglobin measurements in the first 5 Postoperative Days (POD) were included. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM – ICU), preceded by the Richmond Agitation and Sedation Scale, with patients excluded from assessment if sedated. Patients had daily hemoglobin measurements, continuous cardiac monitoring plus twice-daily 12-lead electrocardiograms, up to POD4. AF was diagnosed by clinicians blinded to hemoglobin levels.</p></div><div><h3>Results</h3><p>Five hundred and eighty-five patients were included. Mean postoperative hemoglobin Hazard Ratio (HR): 0.99 (95% CI 0.83, 1.19; <em>p</em> = 0.94) per 1 g.dL⁻¹ hemoglobin decrease. 197 (34%) developed AF, mainly on POD = 2.3. Estimated HR = 1.04 (95% CI 0.93, 1.17; <em>p</em> = 0.51) per 1 g.dL⁻¹ hemoglobin decrease.</p></div><div><h3>Conclusions</h3><p>Most patients undergoing major cardiac surgery were anemic in the postoperative phase. AF and delirium occurred in 34% and 12% of patients, respectively, but neither were significantly correlated with postoperative hemoglobin.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744424"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000209/pdfft?md5=9d128d7a564713b20085c1344c5c1bff&pid=1-s2.0-S0104001423000209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery? A meta-analysis of randomized controlled trials","authors":"Chunxiao Zhao ,&nbsp;Shuo Liu ,&nbsp;Huiquan Zhang ,&nbsp;Mengqi Gao","doi":"10.1016/j.bjane.2023.07.003","DOIUrl":"10.1016/j.bjane.2023.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Acute Kidney Injury (AKI) is a common complication after cardiac surgery and has been associated with poor outcomes. Dexmedetomidine (DEX) has been shown to confer direct renoprotection based on some animal and clinical studies, but data from other trials came to the opposite conclusion following cardiac surgery. This meta-analysis was conducted to evaluate the effects of perioperative DEX administration on the occurrence of AKI and the outcomes after cardiac surgery.</p></div><div><h3>Methods</h3><p>We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV) duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and mortality.</p></div><div><h3>Results</h3><p>Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48–0.91]; <em>p</em> = 0.01), and there was no significant difference between groups in postoperative mortality (OR = 0.63; 95% CI 0.32–1.26; <em>p</em> = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44]; 95% CI -1.50–0.63; <em>p</em> = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89–0.51; <em>p</em> = 0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76–0.15; <em>p</em> = 0.19).</p></div><div><h3>Conclusions</h3><p>Perioperative DEX reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to DEX administration.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744446"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000702/pdfft?md5=ef98eecea417b1784db31948f1487694&pid=1-s2.0-S0104001423000702-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9885898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of arterial hypotension incidence during general anesthesia induction – target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial","authors":"Ana G.G. Vale ,&nbsp;Catia S. Govêia ,&nbsp;Gabriel M.N. Guimarães ,&nbsp;Laíze R. Terra ,&nbsp;Luís C.A. Ladeira ,&nbsp;Guilherme A. Essado","doi":"10.1016/j.bjane.2024.844503","DOIUrl":"10.1016/j.bjane.2024.844503","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration.</p></div><div><h3>Methods</h3><p>This prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 μg.mL⁻¹, and the Bolus Group, receiving a bolus infusion of 2 mg.kg⁻¹. Both groups also received midazolam 2 mg, fentanyl 3 μg.kg⁻¹, and rocuronium 0.6 mg.kg⁻¹. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes.</p></div><div><h3>Results</h3><p>Twenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (<em>p</em> = 0.85), HR (<em>p</em> = 0.49), SR (<em>p</em> = 0.44), or qCON (<em>p</em> = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, <em>p</em> &lt; 0.001), MAP (90.3 for TCI, 86.2 for bolus, <em>p</em> &lt; 0.006), HR (76.2 for TCI, 76.9 for bolus, <em>p</em> = 0.93), and SR (0.01 for TCI, 5.5 for bolus, <em>p</em> &lt; 0.001), irrespective of time (whole period means), revealed some significant differences.</p></div><div><h3>Conclusion</h3><p>Patients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 4","pages":"Article 844503"},"PeriodicalIF":1.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000253/pdfft?md5=f5db07c12017ce725a202a262a6c0eb1&pid=1-s2.0-S0104001424000253-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of low dose intra-articular S(+) ketamine on osteoarthritis in rats: an experimental study","authors":"Eugênio dos Santos Neto ,&nbsp;Pedro Paulo de Alcantara Pedro ,&nbsp;Maria do Socorro de Sousa Cartágenes ,&nbsp;José Osvaldo Barbosa Neto ,&nbsp;João Batista Santos Garcia","doi":"10.1016/j.bjane.2024.844502","DOIUrl":"https://doi.org/10.1016/j.bjane.2024.844502","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to investigate the analgesic impact of S(+)-ketamine on pain behavior and synovial inflammation in an osteoarthritis (OA) model.</p></div><div><h3>Methods</h3><p>Animals were grouped as follows: OA-Saline (n = 24) and OA-Ketamine (n = 24), OA induced via intra-articular sodium monoiodoacetate (MIA); a Non-OA group (n = 24) served as the control. On the 7^th day post OA induction, animals received either saline or S(+)-ketamine (0.5 mg.kg⁻¹). Behavioral and histopathological assessments were conducted up to day 28.</p></div><div><h3>Results</h3><p>S(+)-ketamine reduced allodynia from day 7 to 28 and hyperalgesia from day 10 to 28. It notably alleviated weight distribution deficits from day 10 until the end of the study. Significant walking improvement was observed on day 14 in S(+)-ketamine-treated rats. Starting on day 14, OA groups showed grip force decline, which was countered by S(+)-ketamine on day 21. However, S(+)-ketamine did not diminish synovial inflammation.</p></div><div><h3>Conclusion</h3><p>Low Intra-articular (IA) doses of S(+)-ketamine reduced MIA-induced OA pain but did not reverse synovial histopathological changes.</p></div><div><h3>IRB approval number</h3><p>23115 012030/2009-05.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844502"},"PeriodicalIF":1.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000241/pdfft?md5=8dd8de13116d6acf2227e97190a8eb7c&pid=1-s2.0-S0104001424000241-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140551496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apelin-13 reverses bupivacaine-induced cardiotoxicity: an experimental study","authors":"Xixi Cai ,&nbsp;Le Liu ,&nbsp;Fangfang Xia ,&nbsp;Thomas J. Papadimos ,&nbsp;Quanguang Wang","doi":"10.1016/j.bjane.2024.844501","DOIUrl":"https://doi.org/10.1016/j.bjane.2024.844501","url":null,"abstract":"<div><h3>Introduction</h3><p>Cardiac arrest or arrhythmia caused by bupivacaine may be refractory to treatment. Apelin has been reported to directly increase the frequency of spontaneous activation and the propagation of action potentials, ultimately promoting cardiac contractility. This study aimed to investigate the effects of apelin-13 in reversing cardiac suppression induced by bupivacaine in rats.</p></div><div><h3>Methods</h3><p>A rat model of cardiac suppression was established by a 3-min continuous intravenous infusion of bupivacaine at the rate of 5 mg.kg⁻¹.min⁻¹, and serial doses of apelin-13 (50, 150 and 450 μg.kg⁻¹) were administered to rescue cardiac suppression to identify its dose-response relationship. We used F13A, an inhibitor of Angiotensin Receptor-Like 1 (APJ), and Protein Kinase C (PKC) inhibitor chelerythrine to reverse the effects of apelin-13. Moreover, the protein expressions of PKC, Nav1.5, and APJ in ventricular tissues were measured using Western blotting and immunofluorescence assay.</p></div><div><h3>Results</h3><p>Compared to the control rats, the rats subjected to continuous intravenous administration of bupivacaine had impaired hemodynamic stability. Administration of apelin-13, in a dose-dependent manner, significantly improved hemodynamic parameters in rats with bupivacaine-induced cardiac suppression (<em>p</em> &lt; 0.05), and apelin-13 treatment also significantly upregulated the protein expressions of p-PKC and Nav1.5 (<em>p</em> &lt; 0.05), these effects were abrogated by F13A or chelerythrine (<em>p</em> &lt; 0.05).</p></div><div><h3>Conclusion</h3><p>Exogenous apelin-13, at least in part, activates the PKC signaling pathway through the apelin/APJ system to improve cardiac function in a rat model of bupivacaine-induced cardiac suppression.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844501"},"PeriodicalIF":1.3,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S010400142400023X/pdfft?md5=64b95cf8c618c291285d66448c72f6bc&pid=1-s2.0-S010400142400023X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140542610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid therapy and pulmonary complications in abdominal surgeries: randomized controlled trial","authors":"Gabriel Isaac Pereira de Castro ,&nbsp;Renata Sayuri Ansai Pereira de Castro ,&nbsp;Rodrigo Moreira e Lima ,&nbsp;Bruna Nogueira dos Santos ,&nbsp;Lais Helena Navarro e Lima","doi":"10.1016/j.bjane.2024.844500","DOIUrl":"10.1016/j.bjane.2024.844500","url":null,"abstract":"<div><h3>Background</h3><p>There is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy.</p></div><div><h3>Methods</h3><p>Randomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS).</p></div><div><h3>Results</h3><p>Forty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (<em>p</em> = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (<em>p</em> = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (<em>p</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>The GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 4","pages":"Article 844500"},"PeriodicalIF":1.3,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000228/pdfft?md5=c8ad0071a7100e86aca972abfac00f6a&pid=1-s2.0-S0104001424000228-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study","authors":"Shirley Andrade Santos ,&nbsp;Fernando Souza Nani ,&nbsp;Elaine Imaeda de Moura ,&nbsp;Diogo Lima de Carvalho ,&nbsp;Guilherme Jorge Mattos Miguel ,&nbsp;Cristiane Maria Federicci Haddad ,&nbsp;Joaquim Edson Vieira ,&nbsp;Victor Bunduki ,&nbsp;Mário Henrique Burlacchini de Carvalho ,&nbsp;Rossana Pulcineli Vieira Francisco ,&nbsp;Daniel Dante Cardeal ,&nbsp;Hermann dos Santos Fernandes","doi":"10.1016/j.bjane.2024.844495","DOIUrl":"10.1016/j.bjane.2024.844495","url":null,"abstract":"<div><h3>Background</h3><p>Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as β2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair.</p></div><div><h3>Methods</h3><p>Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery.</p></div><div><h3>Results</h3><p>Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, <em>p</em> = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL⁻¹ vs. 13.06 ± 6.35 mg.dL⁻¹, for atosiban, <em>p</em> = 0.001) levels.</p></div><div><h3>Conclusions</h3><p>Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844495"},"PeriodicalIF":1.3,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000174/pdfft?md5=dbaa845b4aa6c764f06ad927577cbfab&pid=1-s2.0-S0104001424000174-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}